PANEL 4.1 MALNUTRITION IN THE UNITED STATES AND UNITED KINGDOM JESSICA FANZO
N
utrition is a concern in all countries, not just low-income ones. Many high-income coun- tries are struggling with their own nutrition issues. In the United States, where obesity rates have more than doubled in adults and chil- dren since the 1970s, obesity is a leading public health problem. Nearly 69 percent of US adults and 32 percent of children and ado- lescents are overweight or obese (Ogden et al. 2014). In most sex-age groups, the prevalence of obesity is lower among whites than among blacks and Mexican-Americans (May et al. 2013). Many US households suffer not only from the consequences of overweight and obesity, but also from food insecurity. In 2012, 14.5 percent of US households were food insecure, as defined by the US Department of Agriculture, at some time during the year. In the United Kingdom, 67 percent of men
and 57 percent of women are overweight or obese (Ng et al. 2014). More than a quarter of children are also overweight or obese (26 per- cent of boys and 29 percent of girls). In West- ern Europe, the United Kingdom lags behind only Iceland, where 74 percent of men and 61 percent of women are overweight or obese, and Malta, where the figures are 74 percent and 58 percent respectively (Ng et al. 2014). Recent data suggest that the rise in obe- sity among children is flattening in the United States (Ogden et al. 2014). Another study shows that prevalence of childhood obesity has slowed, or leveled off, in nine countries, including Australia, China, and England as well as in the United States (Olds et al. 2011). Although it is too early to understand the causes of this trend, there are some examples of policy change that will be important for
countries to consider as they begin to grapple with the issue. Some countries in Europe are proposing to address the obesity epidemic using a multisectoral government approach, focusing on improving school lunches, con- trolling advertising and marketing to children, taxing junk foods and overprocessed foods, and promoting physical activity (World Health Organization Regional Office for Europe 2014). Some countries, such as Mexico, are taxing unhealthy foods. The United States, United Kingdom, and other high-income countries must be account- able for making progress toward the WHA tar- get on preventing an increase in the number of children under five who are overweight. A whole-of-government approach, as proposed by some European countries, should be con- sidered, taking into account the local context.
TABLE 4.3 COUNTRIES WITH OVERLAPPING UNDER-FIVE STUNTING, ANEMIA IN WOMEN OF REPRODUCTIVE AGE, AND ADULT OVERWEIGHT Overlap/indicator group
Under-five stunting only WRA anemia only
Adult overweight only
Under-five stunting and WRA anemia only
Number of countries 3 3
12 47
Total population (millions) 194 102 873
2,758 Countries
Ethiopia, Rwanda, Viet Nam Senegal, Sri Lanka, Thailand
Argentina, Brazil, Chile, Colombia, Costa Rica, Germany, Mexico, Paraguay, Peru, The former Yugoslav Republic of Macedonia, United States, Uruguay
Angola, Bangladesh, Benin, Bhutan, Burkina Faso, Burundi, Cambodia, Central African Republic, Chad, Comoros, Congo, Côte d’Ivoire, Democratic People’s Republic of Korea, Democratic Republic of the Con- go, Djibouti, Eritrea, Gambia, Ghana, Guinea, Guinea-Bissau, Haiti, India, Indonesia, Kenya, Lao People’s Democratic Republic, Liberia, Madagascar, Malawi, Mali, Mozambique, Myanmar, Namibia, Nepal, Niger, Nigeria, Pakistan, Philippines, Sierra Leone, Somalia, Sudan, Tajikistan, Timor-Leste, Togo, Uganda, United Republic of Tanzania, Zambia, Zimbabwe
Adult overweight and under- five stunting only
WRA anemia and adult over- weight only
Under-five stunting, WRA ane- mia, and adult overweight
Below cutoff for all three indicators
Total with data
Missing data for at least one indicator
Total 2 29 14 438 Honduras, Nicaragua
Algeria, Belarus, Belize, Bosnia and Herzegovina, Dominican Republic, Gabon, Georgia, Guyana, Iran, Jamaica, Jordan, Kazakhstan, Kuwait, Kyrgyzstan, Malaysia, Mongolia, Montenegro, Morocco, Oman, Panama, Republic of Moldova, Saint Lucia, Saudi Arabia, Serbia, Suriname, Tunisia, Turkey, Uzbekistan, Venezuela
24 2
122 71
193
Source: Indicator data are from UNICEF, WHO, and World Bank (2014; data are from 2005–2013); Stevens et al. (2013); and World Health Organization (2014g; data from 2008). Population data are from United Nations (2013b).
Note: WRA = women of reproductive age. The cutoffs for placing countries in each indicator category are as follows: under-five stunting ≥ 20 percent, WRA anemia ≥ 20 percent, and adult overweight ≥ 35 percent. These cutoffs were selected because they are considered to indicate public health significance by WHO (2010a).
ACTIONS & ACCOUNTABILITY TO ACCELERATE THE WORLD’S PROGRESS ON NUTRITION 25 321 1,426 6,126
Albania, Armenia, Azerbaijan, Bolivia, Botswana, Cameroon, Ecuador, Egypt, El Salvador, Equatorial Guin- ea, Guatemala, Iraq, Lesotho, Libya, Maldives, Mauritania, Papua New Guinea, Sao Tome and Principe, Solomon Islands, South Africa, Swaziland, Syrian Arab Republic, Vanuatu, Yemen
China, Republic of Korea
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